Diagnostic and therapeutic value of naloxone after intoxication with tramadol in a young girl.

摘要

Tramadol therapy has gained wide popularity in the last few years, not only with regard to cancer patients on chronic pain therapy, but also in other acute or chronic pain problems. It is an atypical analgesic, which is contraindicated in infants below 1 year of age. Tramadol has a dual mechanism of analgesic action. It inhibits re-uptake of norepinephrine and serotonin, in addition to mu-opioid receptors agonism. The former action is mostly due to the parent compound tramadol, while its metabolite O-demethyltramadol (Ml) exerts its primary action at the mu-opioid receptor. Tramadol metabolite Ml is mainly formed by genetically polymorphic cytochrome P450 (CYP) 2D6. In extensive CYP2D6 metabolizers the analgesic effects of tramadol are superior to those in poor metabolizers.1 Unintentional intoxication with severe central nervous system (CNS) depression and seizures has been reported in small children. We report a case of tramadol intoxication in which treatment with naloxone was diagnostic and therapeutic.